Annamalai and Selvaraj have reported in birds that following receipt of a coccidial vaccine, the mRNA level of CXCR5 in some specific organs increased substantially [29]. Also Guo et al. have shown that fusion of a vaccine antigen directly to CXCL13 could enhance DNA vaccine potency [30].

Thus, the Selleckchem GDC973 linkage of CXCR5, CXCL13 polymorphisms to HBV vaccine efficacy is consistent with these other studies indicating that TfH cells played a critical role in antibody production. The majority of previous studies have suggested that circulating CXCR5+CD4+ T cells have the essential features similar to the TfH cells from lymphoid organs [31] and [32]. So we compared the CXCR5 positive populations in CD3+CD4+ T cells or CD3−CD19+ B cells in peripheral blood from different genotype populations. In an attempt to demonstrate an association between the SNPs in the 3′-UTR (rs3922 and rs676925) and

gene expression level, 29 healthy volunteers were recruited and genotyped. This was necessary because of the paucity of RNA or PBMCs from the responders and non-responders to HBV vaccination making up the study cohort. Individuals with rs3922 “GG” genotype had a higher CXCR5 expression level in the blood OSI-906 ic50 than “non-GG” groups. This observation was concordant with our luciferase assays and hence the data suggested that “G” allele may correlate with a relative high gene expression. In the current study, a role for miR-558 was excluded and the detailed mechanism by which the “G” allele favors CXCR5 gene expression remains unknown. It appears counter-intuitive that the “G” allele, which is associated with the non-responder phenotype, should from correspond to a higher expression of CXCR5. However, it remains unclear whether higher CXCR5 expression on TfH cells will enhance their B cell help function. In fact, Bentebibel et al. have reported that, in human tonsils, the CD4+ subset (CXCR5loCD4+) expressing low levels of CXCR5 secreted more IL-21 and IL-10 than the high expression subset (CXCR5hi). They also appeared to provide more efficient help for the differentiation of naive B cells into Ig-producing cells outside the germinal

center [33]. Overall, this study supports the idea that polymorphisms in CXCR5 and CXCL13, two of TfH associated genes, are closely related to the non-responsiveness to HBV vaccination. The restricted number of non-responsive individuals in our cohort population and the consequent limitation in the availability of blood samples precluded further investigation of how the polymorphisms in CXCR5 and CXCL13 might affect the functioning of these genes. Therefore, how the expression levels of these genes can affect the efficacy of HBV vaccination is still a puzzle. However, achieving a better understanding of the functions of CXCR5 and CXCL13, particularly in response to HBV vaccination, may provide clues that can facilitate optimization of HBV vaccines.

In contrast, the number of eosinophils and neutrophils was dramatically reduced in infant PCV7 immunized group mice compared with the OVA group (2.15 ± 0.29 × 104 cells/mlvs 14.75 ± 1.77 × 104 cells/ml, 20.13 ± 3.7 × 104 OTX015 mouse cells/ml vs 63.39 ± 9.28 × 104 cells/ml, respectively, P < 0.001) ( Fig. These data demonstrated that infant PCV7 immunization can suppress OVA-induced airway eosinophilic and neutrophilic inflammation in young adulthood BALB/c mice asthma model. In control group mice, there was little tissue inflammation. Pulmonary alveolar, peribronchiolar and perivascular inflammatory infiltrate of inflammatory cells in OVA group mice was denser than that in control group mice. In infant PCV7 immunized group mice, pulmonary alveolar,peribronchiolar and perivascular cellular infiltration significantly lower than Alectinib that in OVA group (Fig. 2). As shown in Fig. 3, the inflammation scores of pulmonary alveolitis, pulmonary perivasculitis and pulmonary peribronchiolitis in infant PCV7 immunized mice were significantly lower than that in OVA group (3.00 ± 0.26 vs 1.17 ± 0.17, P < 0.001, 3.67 ± 0.21 vs 2.17 ± 0.31, P < 0.001, 3.33 ± 0.21 vs 1.83 ± 0.31, respectively, P < 0.01). Thus, infant PCV7 immunization suppressed airway inflammation in young adulthood asthmatic mice. AHR was evaluated by the calculation

of Penh values (enhanced pauses) 24 h from after

the final challenge. OVA sensitization and challenge resulted in increased AHR. The Penh value for OVA group was significantly higher than that in the control group at methacholine concentrations 6.25 mg/ml (P < 0.01), 12.5 mg/ml (P < 0.001), 25 mg/ml (P < 0.001), and 50.0 mg/ml (P < 0.001). However, PCV7 + OVA group mice had significantly lower Penh values compared to values obtained from mice in the OVA group from 25 to 50.0 mg/ml (P < 0.001, respectively) ( Fig. 4). To investigate the effects of infant PCV7 immunization on CD4+T cell subsets production during AAD, CD4+T cell cytokines in BALF were analyzed. As expected, OVA sensitized and challenged mice exhibited dramatically increased IL-13, IL-17A production (87.14 ± 7.12 pg/ml vs 40.62 ± 3.59 pg/ml, P < 0.001, 247.70 ± 35.81 pg/ml vs 158.90 ± 16.40 pg/ml, P < 0.05) and significantly decreased IFN-γ, IL-10 production (18.07 ± 1.13 pg/ml vs 33.16 ± 1.87 pg/ml, P < 0.001, 122.30 ± 18.53 pg/ml vs 223.10 ± 35.92 pg/ml, P < 0.05) compared with the control group mice. However, the production of IL-13, IL-17A in the infant PCV7 immunized group mice were significantly lower than that in the OVA group mice(31.93 ± 4.36 pg/ml vs 87.14 ± 7.12 pg/ml, P < 0.001, 120.90 ± 9.56 pg/ml vs 247.70 ± 35.81 pg/ml, P < 0.01). IFN-γ, IL-10 was significantly higher in the infant PCV7 immunized group mice than that in the OVA group mice. (27.89 ± 1.83 pg/ml vs 18.07 ± 1.13 pg/ml, P < 0.001, 228.50 ± 27.47 pg/ml vs 122.30 ± 18.53 pg/ml, P < 0.05).

Due to the nature of the interventions, none of the trials was able to blind the participants or therapists to the intervention. Eight trials blinded the assessor, four trials used intention-to-treat analysis, and eight trials concealed allocation. Sufficient data in the form of means and standard deviations were provided in six trials to allow calculation of effect sizes (Agorastides et al 2007, Bertoft et al 1984, Hodgson et al 2003, Kay et al 2008, Lefevre-Colau et al 2007, Maciel et al 2005). For an additional trial, the mean and standard deviations were imputed

from a graph (Pasila et al 1974). Five trials provided adequate data to estimate means and standard deviations by providing median and interquartile ranges (Krischak et al 2009, Watt et al 2000), means with p values ( Revay et al 1992), and means with standard Ku-0059436 mw errors ( Lundberg et al 1979, Wakefield

and McQueen, 2000). Two trials provided insufficient data to calculate standardised mean differences ( Christensen et al 2001, Hodgson et al 2007). Participants: www.selleckchem.com/products/lee011.html The 13 trials included in the analysis provided data from 781 participants aged from 32 to 82 years, of whom about 80% were female (see Table 2). Participants had sustained either a distal radius fracture (7 trials) or a proximal humeral fracture (6 trials) (see Table 2). No other upper limb fractures were included. Synthesis: Only one meta-analysis could be performed. Clinical heterogeneity between trials precluded further meta-analysis. The results are presented according to the interventions being compared and the type of fracture. Distal radius fractures: There is preliminary evidence from a single trial that exercise combined with advice can improve upper limb activity and reduce pain in the short term after distal radius fracture. A single session of advice and exercise compared to no intervention found improvements in upper limb activity at 3 weeks (SMD 0.61, 95% CI 0.03 to 1.19), and reduced pain at 3 weeks (SMD 0.77, 95% CI 0.18 to 1.36) and 6 weeks 4-Aminobutyrate aminotransferase (SMD 0.63, 95% CI 0.04 to 1.04) ( Kay et al 2008). There were

no other statistically significant between-group differences for the primary outcome measure of wrist extension or for the secondary outcomes of other ranges of motion and grip strength at weeks three or six. Proximal humeral fractures: No trials examined exercise and advice compared to no intervention after proximal humerus fracture. Distal radius fractures: There is no evidence to support adding supervised exercise to a home exercise program after distal radius fracture ( Figure 2). None of the three trials that investigated the effect of physiotherapy-supervised exercise plus a home exercise program compared to a home exercise program alone reported statistically significant betweengroup differences for any impairment or activity outcome measures ( Christensen et al 2001, Maciel et al 2005, Pasila et al 1974).

All animals were challenged, 4 weeks after the last immunisation, intratracheally with 106 median tissue culture infectious dose (TCID50) of the 2009 pandemic influenza virus A/Netherlands/602/2009 (pH1N1) in 3 ml PBS, as described previously [2], [12] and [14]. The virus was routinely propagated in MDCK cell cultures and infectious dose determined as described previously[15], and titres calculated

according to the method of Spearman-Karber [16]. All animals were scanned on −6, 1, 2, 3, and 4 d.p.i. (see also Table 1). A dual-source ultra fast CT-system (Somatom Definition Flash, Siemens Healthcare) was used (temporal resolution: 0.075 s, spatial resolution is 0.33 mm, table speed of 458 mm/s: ferret thorax acquisition time ≈ 0.22 s; enables accurate scanning of living ferrets without the necessity of breath-holding, respiratory gating, or electrocardiogram (ECG)-triggering) as previously Crizotinib manufacturer described [11]. Briefly, during scanning the ferrets were in dorsal recumbency in a purposely built (Tecnilab-BMI) Abiraterone perspex biosafety container of 8.3 L capacity. The post-infectious reductions in aerated lung volumes were measured from 3-dimensional CT reconstructs using lower and upper thresholds in substance densities of −870 to −430 Hounsfield units (HU). Following euthanasia by exsanguination

all animals were submitted for necropsy. The lung lobes were inspected and lesions were assessed while the lung was inflated. The trachea was cut at the level of the bifurcation and the

lungs were weighed. The relative lung weight MycoClean Mycoplasma Removal Kit was calculated as proportion of the body weight on day of death (lung weight/body weight × 100). All animals from both groups were scanned 6 days prior to virus inoculation to define the uninfected base-line status of their respiratory system. Consecutive in vivo imaging with CT scanning showed that ferrets intranasally immunised with the vaccine candidate were largely protected against the appearance of pulmonary ground-glass opacities, as is shown by means of transversal CT images in Fig. 1. The ALVs measured from 3D CT reconstructs likewise showed that the immunised ferrets were protected against major alterations in ALV (group mean ALV ranging from 0.95 to −7.8%) and did not show a temporal increase in ALV on 1 dpi, which was observed in the placebo group (group mean ALV ranging from 17.3 to −14.3%) ( Fig. 2). This sudden and short increase of 17.3% (Mann–Whitney test, two-tailed, P = 0.035) in the unprotected placebo-treated animals may result from a virally-induced acute respiratory depression with compensatory hyperinflation. A compensatory increase in respiratory tidal volume by means of hyperinflation is a pathophysiological phenomenon known to occur in respiratory viral infections [17] and [18]. However, CT scanning could not discern possible emphysema due to ruptured alveoli as cause of ALV increase.

Yealy et al conducted a study on 32 Emergency Departments (EDs) in Pennsylvania and Connecticut, randomized to a low-, moderate-, or high-intensity intervention for the management of patients with CAP. It was found that 167 (37.5%) of the 445 eligible patients at a low risk for mortality in the low-intensity group were treated on an outpatient basis; whereas, 461 (61%) of the 756 eligible patients at low risk for mortality in the moderate-intensity group

and 433 (61.9%) of the 700 eligible patients at low risk for mortality in the high-intensity group were GSK126 molecular weight treated as out-patients.17 Furthermore, a follow up study enumerated the reasons why 845 patients at low risk were admitted to the hospital. These patients were all in PSI risk class II and III, had evidence of medical or psychosocial conditions that were not addressed by the PSI and multilobar

infiltrates, and were receiving therapy with oxygen at home and corticosteroids or antibiotics before presentation. Twenty percent had no identifiable risk factors for hospitalization other than PSI class II or III.17 Moreover, Marrie and Huang (2005), carried out a prospective observational study of patients who were at low risk for mortality (PSI risk classes I and II) and were admitted to 6 hospitals and 1 ED in Edmonton, Alberta and Canada. Their research showed that 586 (19.1%) Ixazomib clinical trial of 3065 patients at low risk were admitted; 48.4% of these patients remained in the hospital for more than 5 days due to comorbidities.18 Another prospective observational study of patients with CAP from 8 French EDs that used the PSI to guide the site of treatment decision (PSI-user EDs) and 8 French EDs that did not use the PSI (PSI-nonuser EDs). For the EDs that used the PSI to guide treatment, 92 (42.8%) of 215 eligible patients at low risk were treated as out-patients; in the EDs that did not use PSI to guide treatment, 56 (23.9%) of 234 eligible patients at low risk were treated

as out-patients.18 In a recent study, others regarding the reasons why ED providers do not rely on the pneumonia severity index to determine the initial site of treatment for patient with pneumonia, there were 1306 patients with CAP (689 low risk patients and 617 higher risk patients). Among these patients, physicians admitted 258 (37.4%) of 689 low risk patients and treated 20 (3.2%) of 617 higher risk patients as out-patients.18 In a similar manner, in this study, physicians admitted 10 cases (37%) of 27 low risk patients and treated 1 case (12.5%) of 8 high risk patients as an out-patient. The most commonly reported reasons for admitting low risk patients in a study by Renaud et al was the presence of a comorbid illness (71.5%); a laboratory value, vital sign, or symptom that precluded emergency department discharge (29.3%); or a recommendation from a primary care or a consulting physician (19.3%).

The pneumococcal capsule is thought to be the main determinant of carriage prevalence and invasiveness and hence the determinant of prevalence amongst disease isolates [11] and [12]. However, it has been speculated that increases in serotype 19A IPD in particular are perhaps attributable to a capsular switch event after being found associated with a sequence

type (ST), ST695, previously only linked with vaccine serotype 4 [13] and [14]. Other studies have documented increases due to the expansion of multi-drug resistant STs such as ST276 and ST320 [15] and [16]. Thus, it is increasingly important to examine both STs and serotypes involved in IPD to determine the potential effectiveness of serotype-specific pneumococcal vaccinations. In September 2006, PCV7 was introduced to the National Health Service childhood immunisation 3-MA nmr schedule in the UK

in a three dose programme at age 2, 4, and 13 months, with a catch-up for those aged up to 2 years. In 2010, 94% of PFI-2 the targeted group had received three doses of PCV7 [17]. This study examines trends in serotype and ST distributions prior to PCV7 use in Scotland, adding to existing reports on the pre-vaccine period in Scotland [18] and [19]; the effect of PCV7 on IPD incidence; trends in serotype and ST distribution post-vaccination; and the association between serotype and ST pre- and post-vaccination. The Scottish Invasive Pneumococcal Disease Enhanced Surveillance (SPIDER) database contains all cases of IPD, identified by blood or cerebrospinal fluid, in Scotland from 1999–2010. The serogroup responsible for each case of disease was available for all years; serotype and ST information was available from 2002.

Clinical isolates (from blood or cerebrospinal fluid) of S. pneumoniae were sent to the Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory (SHLMPRL) after identification at diagnostic microbiology laboratories. These were grown on Columbia blood agar Carnitine palmitoyltransferase II (Oxoid, UK) at 37 °C under anaerobic conditions using an anaerobic pack (Oxoid, UK) and after a single subculture were stored at −80 °C on Protect beads (M-Tech Diagnostics, UK). Isolates were serotyped by a coagglutination method [20]. Multi-locus sequence typing was performed as described previously [21], [22] and [23]. Epidemiological years from winter of one year to the end of autumn of the next were used ensuring winter seasons were grouped together since IPD predominantly occurs in winter. Serotypes and STs were classified according to their joint occurrence prior to PCV7 use (1999–2005) and emergence post-PCV7 (2006–2010). STs were classified as associated with PCV7 serotypes if they occurred at least once in conjunction with a PCV7 serotype (labelled PCV7-ST); otherwise they were classified as not associated (NonPCV7-ST). STs which only occurred following PCV7 use were classified as PostPCV7-ST.

3, Table 2). Evidence on indirect impact in low-coverage (<70%) settings

is mixed, with significant impact seen in some populations and not others. Data on indirect effect of PCV on AT–IPD showed a trend toward increasing impact with time (median decrease: 33%; IQR: 7–42%), though buy Regorafenib with lower overall impact compared to that on VT-IPD (Appendix B.3, Table 3). This impact on AT-IPD was observed in all non-target age-groups (Fig. 5) and is also noted in pneumococcal pneumonia [10] and [29]. Data from mixed target and non-target groups show a greater decrease in VT-IPD rates than that in pure non-targeted groups, reflecting a mix of direct and indirect effect (Appendix B.3, Table 4). However, studies with 1-dose coverage data suggest a vaccine impact on VT-IPD that cannot be entirely accounted for by direct effect. Data were available for six unique populations: Australian aboriginals, Alaska Natives, American Indians, Gambians, Israelis and Portuguese TSA HDAC chemical structure (Appendix B.3, Table 5). Studies in children were primarily RCTs; those in adults were primarily observational. The median decrease

in VT-carriage prevalence (among either the study sample or, rarely, the subset who were carriers of any pneumococcal strain) was 77% (IQR 64–80%). Data points did not span a sufficient time range to evaluate time-related trends. The majority of carriage data is drawn from high-risk populations. Few additional supporting data points were identified for NP carriage. Supporting data are listed for pre- vs. post-introduction all-type NP in non-target groups and pre- vs. post-introduction VT-carriage in mixed groups in Appendix B.3, Tables 6 and 7; a discussion is provided in Appendix B.4. A relevant data point not eligible for inclusion due to publication

date comes from an observational study including Native American adults shortly after PCV introduction Oxalosuccinic acid (2001–2002) and subsequently (2006–2008), finding a relative decrease of 97.5% and an absolute reduction of 4.0% in VT-NP [46]. Most individual data points were categorized as low or very-low quality by GRADE criteria because nearly all data were from observational studies, and over half the primary evidence sources were further downgraded for including only high-risk populations, but few for methodological issues (Appendix B.5). While GRADE methodology categorizes observational studies as ‘low quality’, the GRADE system was designed to assess individual patient treatments, not to assess public health benefit. Furthermore, only observational, or community randomized studies can assess population-level post-introduction effects. An additional 14 studies published after the PCV Dosing Landscape Review search met primary evidence inclusion criteria.

Large scale qualitative research suggests that the median age of sexual debut is approximately 14 although self-reporting in surveys suggests 16–17 years [23] and [24]. Primary school enrolment is generally very high in Tanzania: officially, the net attendance ratio for the primary-school age (7–13 years) population in Mwanza is 73.4% among boys and 76.3% among girls [25]. Part of the main trial preparations involved a check of pupil attendance records prior to the start of vaccination; the proportion of pupils absent on any one day

ranged between 9.6 and 19.7% for Year 6 pupils and between 8.1 and 23.5% for all pupils in Years 4–7 [12]. Nine female health workers were interviewed; all but one had two years of nursing education. All had heard of cervical cancer but their Z-VAD-FMK cost knowledge was limited and often inaccurate. When asked about cervical cancer symptoms, they mentioned vaginal bleeding, smelly vaginal discharge, or pain during sexual intercourse. OSI-906 mw Only two nurses identified HPV as the cause of cervical cancer. Both had heard about HPV through preparatory work for an immunogenicity and safety trial of the bivalent HPV vaccine in Mwanza (2009–2010). Another nurse had heard of HPV vaccines on the radio but could not remember any

details. All nurses mentioned a wide range of, sometimes incorrect, causes of cervical cancer such as poor genital hygiene, early age at childbirth, frequent childbirth, abortion, wearing nylon undershorts and insertion of traditional medicines. Most parents recognized cancer as a serious, potentially deadly illness, but knew little about cervical cancer. Two parents (participating in an GD) had heard about

it on the radio but did not remember any details. One 53-year-old father (participating in an IDI) heard information on the radio but incorrectly thought that cervical cancer affected women during pregnancy or menstruation, when poor vaginal cleansing caused women to contract germs and then cancer. Four parents (GD) and two mothers (IDI) had heard of uterine, but not cervical cancer. No parent had heard about HPV or the HPV vaccine. The female pupils had heard of cancer in general, but none of the 49 girls in GDs had heard about Chlormezanone cervical cancer, HPV or the HPV vaccine. Similarly, teachers had heard of cancer but only 1 of 37 knew about cervical cancer, and no teacher had heard of HPV or the HPV vaccine. One 48-year-old female teacher (IDI) talked about a family member who had “died of cervical cancer” but recalled little about the disease. Religious leaders interviewed knew about cancer in general but nothing of cervical cancer, HPV, or the HPV vaccine. Most respondents welcomed a vaccine that prevents cervical cancer. Almost all the adults said they would allow their daughter to be vaccinated since “prevention is better than cure” (female teacher, GD Malulu). All the girls interviewed said they would like be vaccinated to avoid a dangerous disease like cervical cancer.

The reduction in current amplitude during zero flow conditions was likely due to the formation of a diffusion-limited concentration gradient resulting in reduced

surface [Glu], because the ratio of the current amplitudes selleck screening library with and without flow were dependent on the concentration of glutamate in the perfusate, and in all cases the amount of glutamate transported was <1% of the total glutamate in the chamber (i.e. a pseudo-infinite glutamate source; Fig. 1B–D). This gradient was also reflected in a significant shift in the concentration-dependance of steady-state currents in flow and stopped-flow conditions (KM value for l-glutamate of 32 ± 2 and 216 ± 37 μM, respectively, n = 4; p < 0.002), while the Imax values were not significantly different. Glutamate transporters are

expressed at different densities among structures in the CNS, and transporter density and/or kinetics can be altered in different pathological circumstances such as trauma and ischemia. Because steady-state ambient [Glu] reflects a homeostatic balance of uptake and leak sources, changes in transport may result in significantly different steady state glutamate levels. We tested the influence of the surface density of glutamate transporters on the concentration gradient formed by passive glutamate diffusion during stopped-flow experiments by monitoring currents induced by 10 μM glutamate. With increasing transporter expression levels, the steepness of the concentration gradient formed during stopped-flow conditions was click here increased, as reflected in the changing ratio of the steady-state currents in flow and stopped-flow conditions (Fig. 2A and B). Even with continuous flow, evidence for formation of a concentration gradient between the cell surface and bulk solution was observed. Oocyte

membranes have a microvillar structure that can act as tortuous diffusion barrier (see Supplisson and Bergman, 1997). In a group of 29 oocytes with varying expression levels, steady-state KM values measured with chamber flow (20 mm/s) increased approximately 4-fold as transporter current induced by 1 mM glutamate increased from ∼200 to ∼1100 nA ( Fig. 2C and D). Thus, there is an effect of the concentration heptaminol gradient formed by transporters even with continuous flow, resulting in a discrepancy between the measured and actual glutamate KM value. We extrapolated a linear function relating the measured KM value to the transport current density ( Barry and Diamond, 1984), yielding an estimate of the intrinsic KM value of approximately 27 μM (r = 0.78; Fig. 2D). While the dependance of steady-state KM on transporter density reflects the fact that the true glutamate concentration at the cell surface is reduced by uptake, the concentration difference associated with the diffusion gradient is minimal at when high concentrations of glutamate are applied by continuous flow.

(Patient A) In many ways the themes were similar

between the two groups and overall both physiotherapists and patients found many aspects of the process helpful. The coaching process helped the focus of rehabilitation to stay on the patients’ expressed needs. This resulted in interventions being more in line with expressed desires. The physiotherapists described this focus resulting in a fresh perspective; for the patients, this focus on their expressed needs lead to greater sense of involvement. However the most striking difference relates to the emotional responses which were often in contrast to the physiotherapists’ own responses. Some examples of these contrasting perspectives are presented in Box 4. Physiotherapist description of the patient’s perspective Patient’s CCI-779 nmr perspective Actually to be honest, I was a bit concerned about how my client would actually respond to it. He has a lot of social things going on in his life… that aren’t so good… whether it unearthed stuff. (Physiotherapist A) I liked how it helped me to motivate myself… The whole thing was pretty cool. (Patient A) [This] was one of those situations where I just couldn’t see it fitting in and working… so it made the whole process quite difficult. (Physiotherapist D) She was positive and on my side … She seemed to get to BGB324 concentration the heart of the matter … She seemed

to be more on board with fixing my problem. (Patient D) I don’t know if it would have added a whole lot [of value]. (Physiotherapist F) The goals we have set have helped generally in all areas of the things I do, not just in physio. (Patient F) Full-size table Table options View in workspace Download as CSV Overall the activity

coaching approach was considered to be useful and acceptable nearly to these rehabilitation patients. This framework was reported to promote interactions between physiotherapists and patients and gave greater insight for the physiotherapists into patients’ expressed needs and preferences. The process was also perceived to increase the active involvement of patients in the rehabilitation process and promote self-responsibility while also providing emotional support. Activity coaching therefore does appear to have the potential to support patient-centred practice and the development of the therapist-patient relationship, which has been linked to better outcomes for rehabilitation patients (Hall et al 2010, Pinto et al 2012) and improved satisfaction with care (Oliveira et al 2012). An unexpected finding from this study was the emotional discomfort experienced by physiotherapists. The historical school of thought underlying physiotherapy practice primarily is a ‘body as a machine’ or biomechanical discourse (Nicholls and Gibson 2010).